HIT Happens

Health data interoperability in sight ... via Epic?

CIOs: Time to capitulate to Epic in regards to health data interoperability? ONC: It's a big country, and there's a lot more than Epic out there.

NEW YORK -- At the Union League Club ballroom, the site of HealthImpact East, it sounded almost as if healthcare providers were throwing in the towel on health data interoperability and capitulating to Epic Systems Corp., which itself wasn't exactly working out. To wit:

  • At the open breakfast discussion shaping the day's content, one attendee lamented the lack of national patient identifier, postulating medical record numbers in Cerner Corp. and Epic EHR systems are becoming de facto patient IDs, if they haven't already.
  • Partners HealthCare and its upcoming $600 million Epic implementation was represented in that discussion.
  • The keynote was delivered by a dynamic and energetic Ramanathan Raju, who took over as CEO of New York Health and Hospitals Corp., fresh off of turning around the financially crippled Cook County Health and Hospital System in Chicago (a Cerner customer) and plans to do the same in New York with the help of ... an Epic install.
  • Epic customer Shafiq Rab, M.D., vice president and CIO of Hackensack N.J. University Medical Center, told the audience the still-fresh story of his wife's cardiac scare the previous week. From the perspective of a deeply connected-yet-frustrated health system CIO trying to move her EKG tests between three hospitals, his conclusion was that data exchange isn't working yet, but it will be in a decade. For now, "It's your freaking life. Make copies of all of your health records, keep [them] on your iPhones and Droids ... if you want to live."
  • Daniel Barchi, CIO of both Yale New Haven Health System and Yale University School of Medicine, described as "imperfect" health data exchange via HL7 continuity of care document standards. That makes it difficult to interact with providers who use disparate software vendors. His health system addressed the problem by recently implementing Epic systemwide, to the tune of $300 million.

"It frustrated us for a long time," said Barchi of Yale's interoperability problems between inpatient and outpatient settings. "We addressed the issue simply by forcing everybody to use the same tool."

All of this wasn't troubling because it's Epic, per se. On the minus side, some health IT leaders believe that the Wisconsin EHR vendor's products create "walled gardens" of semi-interoperable health data that limit patients' choice of healthcare providers. On the plus side, Epic is popular. Like the 1970s IT axiom "nobody ever got fired for buying IBM equipment," today nobody ever gets fired for choosing Epic.

The troubling idea is this: If the market capitulates to one or two commercial vendors, it takes standards development out of public-private advisory committees and ultimately the ONC. It's one thing to own a commercial data standard like Adobe PDF or Microsoft Excel document format. It's quite another to monetize a person's access to healthcare.

We also happen to like Epic. We like what they're doing, but we don't think they're the answer -- we think they're one of many players.

Thomas Novak,
ONC

So during the questions-and-answers time for a panel featuring Barchi, Thomas Novak, director of ONC's Delivery System Reform in the Office of Provider Adoption and Support, Weill Cornell CIO Curtis Cole, M.D., and Paul Tang, M.D., vice chair of the federal Health Information Technology Policy Committee, I voiced a concern others in the audience later confirmed they were thinking: "It feels like ONC is outsourcing interoperability to Epic. Could that be true? Talk me back from the ledge."

The short answer? No, despite appearances. Even if the agency was, Epic can't solve interoperability on its own.

Cole said that ultimately, interoperability is the responsibility of the healthcare provider, even though large health systems might "enjoy using the vendors as whipping boys to blame for our lack of HIE. We're outsourcing the blame."

Barchi agreed, saying that no one's yet achieving interoperability, even health systems like Yale running a single EHR across all care settings. "None of the large health systems who are using the Epics, Cerners or Allscripts [Healthcare Solutions, Inc.] of the world are sitting on their heels expecting their vendor to do this piece of it, because it's not being well done by our vendors. So we're the ones trying to find other ways around it," he said, adding that he believes population health management mandates in the next two years will also force open the floodgates for data sharing in U.S. healthcare like never before.

That sentiment was echoed later by Novak, who wrote some of the Medicaid meaningful use program rules. He pointed out that there's a lot more than Epic EHRs running in U.S. healthcare. In the future, he believes there will remain a need for consensus -- as opposed to vendor-driven -- health data standards driving interoperability as reimbursement dollars flow toward measuring outcomes in population health, even if current market forces seem to indicate a battlefield tilting toward a few large EHR vendors.

"Our standards for interoperability are different from [large EHR vendors'] standards," said Novak speaking one-on-one with SearchHealthIT after the panel ended. "We aren't pushing [Epic's interoperability framework] Care Everywhere. But we also happen to like Epic. We like what they're doing, but we don't think they're the answer -- we think they're one of many players." 

Editor's note: This story has been updated to reflect that Cook County Health and Hospital System is a Cerner customer, and that Raju was referring to a planned Epic implementation in New York.

Let us know what you think about the story; email Don Fluckinger, news director, or contact @DonFluckingeron Twitter.

This was first published in May 2014
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